RX for the BOTTOM LINE: Choosing the Right Branch Boosts Bottom Line on Orlando Medical News

RX for the BOTTOM LINE: Choosing the Right Branch Boosts Bottom Line

By: MINERVA DEJESUS and AURIANA REYES

In a slowing economy, medical practices may reduce their operating expenses by delegating a portion of essential functions to an infrastructure that will result in lower costs and higher revenue—an infrastructure that can be seen as an extension of your practice.

That infrastructure is an organization with your best interest at heart, one whose bottom line is tied to your success.

While some may call this system “outsourcing,” others call it “a branch.” With the right company, this branch can represent a continuation of care that begins in your office and ends with your patient confident that you not only care about their health, but also their coverage.

You might believe your office manager has unlimited time in their very busy day to explain insurance benefits to your patient, spend countless hours on the phone with an insurance company to get a pesky question answered, and fight for every dollar an insurance company owes you. We all know they have more productive things to do. It's not that they don't care; they simply lack hours in the day.

Many office managers would rather not dwell on medical billing, the questions patients may have when they receive their bill, or the never-ending follow-ups necessary to get problematic claims paid. Medical billing is complex and error-prone, making revenue highly correlated to the skill and talent of the biller. Most practice managers don't even want to think about the possibility that their in-house medical billers may not be billing to derive maximum revenue ... that is, if they are not doing the billing themselves in addition to their many other duties. It does happen! A staggering 40 percent of all medical claims submitted are either returned, underpaid, or denied due to error. And that’s just the average!

It’s good business for insurance companies to deny your claim. If your practice doesn’t have the time or skill to appeal claims in a timely fashion, the process stops there. You’ll never collect on these claims; the insurance company wins. Amazingly, 30 percent of all denied claims are never appealed. That’s good business for the insurance company; bad business for you! Keep in mind that while the physician is the brain of the practice, the medical billing is the heart feeding all departments and keeping arteries flowing. Employees cannot be paid nor do doors remain open if the physicians are not being reimbursed for the services they provide

A better strategy to boost your bottom line: to create a branch or extension to your practice that will do the time-consuming, headache-inducing follow ups. Keeping an open mind and allowing the right branch with qualified professionals to do the job will decrease your overhead and increase your profits.

Here are a few reasons why it makes sense to outsource medical billing:

Assurance that your billing is always being completed by experienced revenue-driven professionals making untimely filing a non-issue and maximum reimbursements a given.
Conversion of medical billing from a fixed expense to a variable expense, based on the volume of your business. A percentage-based medical billing company should get paid after you do, so you’re never putting out more than you’re bringing in. Fair market value for this service is 7-16 percent. This percentage should only be based on what they helped your practice acquire, not overall office income.
Lack of worry about training staff, continuation of education, overwhelmed employees, vacation, maternity leave, emergency leave, et cetera.
Another channel of profitability. Your in-house biller can only follow-up on a limited number of claims, possibly pushing some aside. Once you get to this point, your receivables tend to drop since a percentage of your overall billing is incomplete. The remedy is to hire another biller, but the downside is that overall profitability will drop because of the added staffing expense. This is another issue that can be eliminated by outsourcing your medical billing to the right company who will keep you in control while all finances go directly into your account. You can help cut cost when you outsource because your overhead will never exceed your profit.

Over the years, the word outsourcing has left a bad taste for some. However, it shouldn’t keep anyone from looking into a simple solution that will result in higher income. Let's face it, you didn’t go to medical school to deal with insurance companies and your office manager can’t do it all. The right help is within reach and ready to take your call.

Minerva DeJesus and Audi Reyes founded Simple Solution Billing in Maitland.